For ACOs to succeed, experts tell us that 3 things are required: 1) health information technology is needed to track and manage patient populations, 2) redesigned care delivery processes are needed to support patient care coordination, and 3) the right set of provider financial incentives must be in place.

But the “experts” have overlooked perhaps the most important requirement:

The improvements in quality and cost effectiveness in large part are predicated upon providers being able to engage patients with the goal of changing their health behavior.

"There is a clear need for PCMHs to not only evolve on their current trajectory but also to expand beyond the walls of the health home into the communities where our children live, work, learn and play.

We need to be engaging coaches, teams and teachers (and educating them on the positive and negative effects they are having on our children) to create a patient-centered neighborhood connected to these individuals (and other community resources) and especially to the child and their family in the way THEY need."

"A challenge for primary care providers has been understanding the full scope of care a patient might be receiving, since they don't have data on a patient's visits to the hospital or emergency department or other providers. However, insurance carriers have that broader pool of data since they are paying the claims."

The Mayo affiliation... highlights the importance of networking in today’s health care and the necessity of sharing expertise and best practices. Billings Clinic shares its expertise and resources throughout Montana with physician clinics in Miles City, Bozeman and Cody, Wyo., and provides management and other services to community health centers in Red Lodge, Columbus, Big Timber, Livingston, Colstrip, Scobey, Roundup, Plentywood and Lovell, Wyo. Dozens of Billings Clinic specialists travel to those cities and others in a multistate region to conduct outreach clinics. All of those clinics and hospitals, their staffs and patients are now connected to Mayo.

"Those of us with long memories recall the promise of health maintenance organizations in the '80s and '90s, and we recognize that a health care concept is ultimately only as good as its implementation"

"I'm surprised," says Jonathan Gruber, a health economist at the Massachusetts Institute of Technology. "All the news is about the move to high-deductible health plans. Based on that logic ... I would have expected it to go up."

A cross-cultural survey was used to examine two hypotheses designed to link culture to wellbeing and health. The first hypothesis states that people are motivated toward prevalent cultural mandates of either independence (personal control) in the United States or interdependence (relational harmony) in Japan. As predicted, Americans with compromised personal control and Japanese with strained relationships reported high perceived constraint. The second hypothesis holds that people achieve wellbeing and health through actualizing the respective cultural mandates in their modes of being. As predicted, the strongest predictor of wellbeing and health was personal control in the United States, but the absence of relational strain in Japan.

"If you're going to need to manage the health of a population, you need to have access to [sub-specialties]," Mr. Halley says. "You can't say in an ACO that you don't [offer] general surgery. You can't run an ACO without…sub-specialists."

"Patients most likely to see the immediate benefits of the program are those who need help managing chronic conditions, such as diabetes or heart disease.

Critical to the program's benefits are clinical care coordinators, employed by Village Health Partners, who help patients with chronic conditions or other health challenges navigate the health care system. The care coordinators are aligned with a team of Cigna case managers to ensure a high degree of collaboration between the medical group and Cigna that ultimately results in a better experience for the individual."

Case in point: My cozy hospital room at UCLA Medical Center in Santa Monica was priced at $4,000 a night. Four thousand. You can book a 1,400-square-foot Premier Suite at the Beverly Hills Hotel for less than that.

...

"It's totally crazy," admitted Dr. David Feinberg, who isn't just some innocent bystander when it comes to UCLA's medical pricing. He's the president of UCLA Health System. He runs the place.

"Our billing system is terrible," Feinberg told me. "I get some explanations of benefits from my insurer, and I don't understand what they are."

Beth Israel Deaconess Medical Center today is unveiling a new accountable care organization, joining a national movement toward defined payments for each patient’s health care, in place of traditional fee-for-service payments.

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